497 research outputs found
Sexual health and function in liver disease
No full textSex is a central aspect of human life and is significantly impacted by chronic illness. Cirrhosis, due to its unique pathophysiology and the side effects of common therapies, serves as a paradigmatic example, being associated with very high rates of sexual dysfunction in both men and women. Liver transplantation can modify certain hormonal and pathophysiological aspects related to sexual dysfunction, but complete recovery occurs in only a relatively small percentage of patients. This review examines the pathophysiology, epidemiology, and management of sexual and reproductive dysfunction in patients with cirrhosis and those undergoing liver transplantation. It provides a framework for understanding the sources of dysfunction, tools for identifying it in clinical settings, and interventions to improve sexual health and functioning in these patients
Predicting Overt Hepatic Encephalopathy for the Population With Cirrhosis
No full textPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149748/1/hep30533.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149748/2/hep30533_am.pd
The optimal timing of hepatitis C therapy in transplant eligible patients with Child B and C Cirrhosis: A Cost-Effectiveness Analysis.
No full textBACKGROUND
Ledipasvir/sofosbuvir (LDV/SOF) has demonstrated high efficacy, safety and tolerability in HCV-infected patients. There is limited data, however, regarding the optimal timing of therapy in the context of possible liver transplantation (LT).
METHODS
We compared the cost-effectiveness of 12 weeks of HCV therapy before or after LT or nontreatment using a decision analytical microsimulation state-transition model for a simulated cohort of 10 000 patients with HCV Genotype 1 or 4 with Child B or C cirrhosis. All model parameters regarding the efficacy of therapy, adverse events and the effect of therapy on changes in model for endstage liver disease (MELD) scores were derived from the SOLAR-1 and 2 trials. The simulations were repeated with 10 000 samples from the parameter distributions. The primary outcome was cost (2014 US dollars) per quality adjusted life year (QALY).
RESULTS
Treatment before LT yielded more QALY for less money than treatment after LT or nontreatment. Treatment before LT was cost-effective in 100% of samples at a willingness-to-pay threshold of 177,381.
CONCLUSION
From a societal perspective, HCV therapy using LDV/SOF with ribavirin prior to LT is the most cost-effective strategy for patients with decompensated cirrhosis and MELD > 13
Nonalcoholic fatty liver disease, metabolic syndrome, and the fight that will define clinical practice for a generation of hepatologists
No full textPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143796/1/hep29722.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143796/2/hep29722_am.pd
A Claims‐Based Frailty Risk Score Is Associated With Hospitalization for Acute‐on‐Chronic Liver Failure: But Is It Frailty?
No full textPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163846/1/lt25921_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163846/2/lt25921.pd
Noninvasive imaging biomarker assessment of liver fibrosis by elastography in NAFLD
No full textKey PointsNAFLD is the most common form of chronic liver disease, and patient-centred risk-assessment strategies are therefore needed for cost-effective careLiver elastography — or liver stiffness measurement — is an alternative to liver biopsy to evaluate patients with NAFLD for the presence of advanced fibrosis or cirrhosisOf the available elastographic modalities, vibration-controlled transient elastography is the most studied and magnetic resonance elastography is the most accurate; ultrasound-based elastography is promising but lacks defined examination quality criteriaFuture research is needed to establish the optimal sequence of modalities for use in the clinic and the definition of clinically meaningful changes in liver stiffnes
Deciphering the Cirrhotic Patient’s Present Status: The Overlap Between Physical Frailty, Disability, and Sarcopenia
No full text- …
